0:00:03.070,0:00:06.899 Lord Ponsonby of Shulbrede 0:00:18.000,0:00:23.400 My Lords, I open by thanking the Minister[br]and noble Lords who are going to take part 0:00:23.609,0:00:30.609 in this important debate. It is about deaf[br]people, by which I mean people who are born 0:00:31.660,0:00:38.660 or become profoundly deaf before the age of[br]five. They usually prefer to communicate in 0:00:39.420,0:00:46.420 British Sign Language and see themselves as[br]part of the deaf community. By this definition, 0:00:47.149,0:00:52.640 there are an estimated 70,000 deaf people[br]in the United Kingdom. 0:00:52.640,0:00:59.640 I am speaking to a deaf health study called[br]Sick of It, launched last week, on 25 March, 0:01:04.610,0:01:09.310 which is the largest and most extensive study[br]of the health of deaf people in the world 0:01:09.310,0:01:16.170 so far. Most of the study was funded by the[br]Big Lottery Fund and carried out by the charity 0:01:16.170,0:01:21.700 SignHealth in partnership with the University[br]of Bristol. I am particularly indebted to 0:01:21.700,0:01:26.650 Dr Andrew Alexander, SignHealth's medical[br]director, who provided me with the briefing 0:01:26.650,0:01:29.360 for this debate. 0:01:29.360,0:01:34.470 Before now, there has never been any research[br]on this scale into the health of deaf people 0:01:34.470,0:01:37.090 in this country.[br]Although there have been a few small studies 0:01:37.090,0:01:44.090 looking at access to health-all found it poor-no[br]Government have ever specifically addressed 0:01:45.610,0:01:51.560 the health of deaf people as I have defined[br]them here. The closest initiative was Mental 0:01:51.560,0:01:57.590 Health and Deafness-Towards Equity and Access.[br]Although this started as a consultation on 0:01:57.590,0:02:03.399 mental health, it included a lot on the wider[br]barriers faced by deaf people. The report 0:02:03.399,0:02:09.470 was supported by funding which was received[br]by each primary care trust to help it implement 0:02:09.470,0:02:13.580 the recommendations of the report. 0:02:13.580,0:02:20.580 Deaf health rarely features on any agenda,[br]with the notable exception of that of the 0:02:20.690,0:02:25.050 House of Lords. Even within health and equality[br]programmes, attention is normally focused 0:02:25.050,0:02:30.640 on groups with a higher profile. It does not[br]help that being deaf is a hidden disability 0:02:30.640,0:02:37.430 and that there is so little awareness of the[br]barriers that deaf people face. This is usually 0:02:37.430,0:02:43.420 the case on the health front line as well.[br]Most staff will think that speaking louder 0:02:43.420,0:02:49.890 or writing things down will solve the problem.[br]When surveyed, a very high percentage of doctors 0:02:49.890,0:02:54.390 wrongly thought that they had communicated[br]well with their deaf patients. 0:02:54.390,0:03:01.390 I turn to the report's methodology and findings.[br]There were three stages to the report: first, 0:03:01.610,0:03:08.610 an online survey was conducted by Ipsos MORI;[br]secondly, personal health assessments were 0:03:09.100,0:03:15.620 made of 298 deaf people, including looking[br]at their blood pressure and BMI and taking 0:03:15.620,0:03:22.500 blood tests, et cetera; thirdly, there were[br]in-depth interviews of deaf people. The findings 0:03:22.500,0:03:28.740 were as follows. First, underdiagnosis and[br]undertreatment of potentially serious conditions 0:03:28.740,0:03:35.660 was more common for deaf people. Secondly,[br]high blood pressure was almost twice as common 0:03:35.660,0:03:41.850 in deaf people as in the rest of the population.[br]Thirdly, deaf people have generally healthier 0:03:41.850,0:03:46.540 lifestyles than the rest of the population[br]in terms of smoking and alcohol but are more 0:03:46.540,0:03:53.480 likely to be overweight. Fourthly, there is[br]underdiagnosis: deaf people are twice as likely 0:03:53.480,0:03:58.760 as hearing people to have high blood pressure[br]that has not been diagnosed and may also be 0:03:58.760,0:04:05.760 more likely to have undiagnosed diabetes,[br]high cholesterol and cardiovascular disease. 0:04:06.680,0:04:12.230 Moving on to poorer treatment, the report[br]also found that when deaf people have been 0:04:12.230,0:04:18.940 diagnosed, they are more likely to be on inadequate[br]treatment for those conditions. It has been 0:04:18.940,0:04:25.310 estimated that if the deaf community had the[br]same health profile as the general population, 0:04:25.310,0:04:28.900 the NHS would save about £30 million per[br]year. 0:04:28.900,0:04:35.900 I will now talk about access and communication.[br]A large number of deaf people reported not 0:04:36.480,0:04:43.090 seeing their GP because they were put off[br]by the prospect of poor communication. A large 0:04:43.090,0:04:49.340 proportion booked appointments by going to[br]the practice in person-some 45%-whereas very 0:04:49.340,0:04:55.900 few hearing people book appointments in this[br]way. Only 15% of deaf people said that their 0:04:55.900,0:05:02.270 GP was good at listening to them, compared[br]to 51% of the general population. At most, 0:05:02.270,0:05:09.270 30% could use BSL in a consultation even though,[br]in total, 94% would prefer to sign. More than 0:05:09.510,0:05:15.610 half had to use an English-based form of communication-for[br]example, lip reading or writing notes-but 0:05:15.610,0:05:22.610 only 5% would prefer to communicate in that[br]way. This disparity between how deaf people 0:05:23.430,0:05:28.680 have to communicate and how they would like[br]to communicate is an indictment of the health 0:05:28.680,0:05:35.680 service, and an explanation for the poorer[br]health outcomes of deaf people. Only 25% of 0:05:36.330,0:05:42.890 deaf people have confidence in their doctor,[br]compared to 67% of the general population. 0:05:42.890,0:05:49.570 There is also a wider issue about access to[br]information. Because health information is 0:05:49.570,0:05:56.250 not widely available in an accessible format,[br]a lot of the deaf people studied were unsure 0:05:56.250,0:06:02.970 about their health and unsure what their prescriptions[br]were for or how to take their medicine. While 0:06:02.970,0:06:08.060 many hearing patients would find out more[br]information from friends, family or the internet, 0:06:08.060,0:06:13.950 these options were less available to deaf[br]patients. As a result, few of the deaf people 0:06:13.950,0:06:20.800 interviewed through the in-depth process appeared[br]actively engaged with their own personal health 0:06:20.800,0:06:24.530 management. 0:06:24.530,0:06:30.490 What are the prescriptions for change? I should[br]just say that change from the point of view 0:06:30.490,0:06:36.430 of the deaf community is about equal rather[br]than special treatment. 0:06:36.430,0:06:41.430 The first prescription is that systems within[br]the health service need to be accessible. 0:06:41.430,0:06:45.870 From booking an appointment to getting test[br]results, there should be a communication agreement 0:06:45.870,0:06:52.710 for each deaf patient, which is then coded[br]and recorded in their patient record. Secondly, 0:06:52.710,0:06:58.240 deaf patients should be able to book appointments[br]online and be able to use texts to communicate 0:06:58.240,0:07:03.300 with services. Thirdly, deaf patients should[br]be able to communicate during consultations 0:07:03.300,0:07:10.300 in their preferred language. Health services[br]must [br]expect and plan for deaf patients. Clinicians 0:07:14.810,0:07:20.530 should remember that interpreters are not[br]just for deaf people but help the doctor to 0:07:20.530,0:07:26.930 understand and diagnose properly. Fourthly,[br]providers must make sure that staff know how 0:07:26.930,0:07:32.840 to book an interpreter and ensure that interpreters[br]are suitably qualified. Fifthly, health information 0:07:32.840,0:07:38.680 needs to be made accessible in other formats,[br]including BSL and subtitles. Currently, only 0:07:38.680,0:07:45.680 10 out of a total of 900 NHS Choices videos[br]are available in BSL. The proposed information 0:07:46.840,0:07:51.830 standard on accessibility should be supported[br]with a funded programme. 0:07:51.830,0:07:58.240 I move on to some questions, which I have[br]given notice of to the Minister. First, are 0:07:58.240,0:08:03.560 there any plans to ensure that NHS Choices[br]increases the number of videos available in 0:08:03.560,0:08:10.560 BSL? Secondly, what would the Minister recommend[br]to a deaf person who wants to see a doctor 0:08:11.669,0:08:17.889 but is told no interpreter is available or[br]that it is too expensive? It was brought to 0:08:17.889,0:08:24.889 my attention earlier today by Dr Clare Redstone,[br]a GP, that it is very common to experience 0:08:26.110,0:08:33.110 problems in booking interpreters. Thirdly,[br]what steps will the Government take to encourage 0:08:33.630,0:08:40.549 the NHS Executive and Public Health England[br]to promote the health of deaf people? Fourthly, 0:08:40.549,0:08:46.060 when can we expect the NHS computer system[br]to be able to tell us how many deaf people 0:08:46.060,0:08:53.060 there are and which services they are accessing?[br]Fifthly, will implementation of the proposed 0:08:53.150,0:08:59.390 information standard be supported with a funded[br]programme which can help to educate and support 0:08:59.390,0:09:02.150 health services? 0:09:02.150,0:09:09.150 My sixth question is one that I sent the Minister[br]earlier regarding whether psychological therapies 0:09:15.820,0:09:21.560 providing BSL should be the responsibility[br]of specialised commissioners. I understand 0:09:21.560,0:09:26.940 that the Minister has since decided that psychological[br]therapies for deaf people should not be on 0:09:26.940,0:09:33.279 the list of prescribed services. Therefore,[br]in the updated situation, my question is: 0:09:33.279,0:09:39.290 how can we ensure that psychological services[br]nationwide are available for deaf people? 0:09:39.290,0:09:46.290 I understand that there is a very patchy covering[br]at the moment. Lastly, what does the Minister 0:09:49.960,0:09:56.040 think would be the best way to raise deaf[br]awareness among staff working in the health 0:09:56.040,0:09:56.410 service? 0:09:56.410,0:10:03.410 I look forward to the Minister's response.[br]I understand that she is working on a cross-governmental 0:10:04.540,0:10:11.540 strategy on hearing loss and that the report[br]on this is ongoing. My debate today is about 0:10:13.610,0:10:19.270 a very specific cohort within that deaf community,[br]and I hope that she will be able to address 0:10:19.270,0:10:23.260 the questions that I have raised. 0:10:23.260,0:10:28.380 My Lords, I am grateful to the noble Lord,[br]Lord Ponsonby, for bringing this matter to 0:10:28.380,0:10:32.690 debate following the SignHealth report. 0:10:32.690,0:10:38.700 I must, first, declare an interest. For about[br]the past 25 years, I have been a trustee of 0:10:38.700,0:10:44.940 the Ewing Foundation for deaf children, a[br]charity that has, for the past 60 years, helped 0:10:44.940,0:10:49.510 to improve the teaching of children who use[br]their residual hearing and lip reading to 0:10:49.510,0:10:52.620 communicate by speech. 0:10:52.620,0:10:58.589 The change in the prospects and outcomes for[br]deaf children due to the introduction of cochlear 0:10:58.589,0:11:03.270 implants, digital hearing aids and newborn[br]hearing screening is one of the most exciting 0:11:03.270,0:11:08.870 stories in disability. Noble Lords may have[br]seen the publicity in the papers on Friday, 0:11:08.870,0:11:14.740 or even the YouTube film, of the joy of a[br]deaf girl of 40 hearing for the first time 0:11:14.740,0:11:20.690 when her cochlear implants were turned on.[br]For the first time, she can hear music, the 0:11:20.690,0:11:26.220 laughter of babies and the songs of birds.[br]This revolution has come from cochlear implants, 0:11:26.220,0:11:31.899 which will radically reduce the disabling[br]effects of profound deafness in children and 0:11:31.899,0:11:32.810 adults. 0:11:32.810,0:11:38.620 The Sick of It report is important and interesting,[br]but I am afraid that it gives away its self-selected 0:11:38.620,0:11:45.050 background. A statistic on the page about[br]communication issues claims that 80% of deaf 0:11:45.050,0:11:49.660 people want to communicate using British Sign[br]Language. The noble Lord suggested that that 0:11:49.660,0:11:56.440 figure was 93%, but I think it is the definition[br]of "deaf" that accounts for the difference. 0:11:56.440,0:12:01.620 That statistic is a conundrum to me, in that[br]the vast majority of deaf people, using a 0:12:01.620,0:12:07.920 more ordinary definition of the word, are[br]elderly people who do not use British Sign 0:12:07.920,0:12:14.920 Language. Indeed, the CRIDE report said that[br]79% of deaf children use only spoken English. 0:12:16.040,0:12:20.399 It may be that the definition of deaf depends[br]on who is hearing it. 0:12:20.399,0:12:27.399 A strong part of good communication is literacy.[br]Unfortunately, communicating through sign 0:12:27.970,0:12:33.770 language while learning to read and write[br]in English is like talking in English and 0:12:33.770,0:12:40.770 reading and writing in Chinese. I am filled[br]with admiration for all the children who can 0:12:41.060,0:12:47.220 do it. Noble Lords may have strong opinions[br]about whether tweeting and texting can really 0:12:47.220,0:12:53.959 be described as literature but they are fundamental[br]to the lives of many teenagers nowadays. There 0:12:53.959,0:12:59.350 is some great technology coming forward. The[br]Apple digital assistant, Siri, and many other 0:12:59.350,0:13:06.070 programs can transcribe your questions, and[br]a doctor's replies can be sent from an iPad 0:13:06.070,0:13:13.070 to a simultaneous remote caption service.[br]All these new technologies need literacy. 0:13:14.320,0:13:20.110 The theme of the report is that good communication[br]is fundamental to good health, and that makes 0:13:20.110,0:13:26.240 sense, but it is true not only of deaf patients;[br]communication with all patients can be made 0:13:26.240,0:13:28.580 better. 0:13:28.580,0:13:34.970 Another feature of the report is isolation,[br]and deafness is very isolating. Research has 0:13:34.970,0:13:41.970 shown that in old age the combination of cognitive[br]decline and hearing loss can be fatal. Hearing 0:13:44.350,0:13:49.580 loss seems to speed up dementia, so perhaps[br]hearing loss in older patients should be treated 0:13:49.580,0:13:54.580 more aggressively when it is first diagnosed,[br]and deaf awareness training given to more 0:13:54.580,0:13:59.440 health professionals. 0:13:59.440,0:14:04.120 Time after time, surveys suggest that there[br]is a correlation between good health and good 0:14:04.120,0:14:09.500 education, so the most powerful advantage[br]to the health of deaf people is to make sure 0:14:09.500,0:14:16.500 that they get a great education. Profoundly[br]deaf children now, thanks to cochlear implants, 0:14:17.720,0:14:23.330 can be educated primarily in mainstream schools,[br]with hearing friends and ordinary prospects 0:14:23.330,0:14:25.519 for the future. 0:14:25.519,0:14:31.970 But cochlear implants are expensive, although[br]not so much in their implantation, which, 0:14:31.970,0:14:38.019 like everything electronic, is improving technically[br]and reducing in price. The real cost comes 0:14:38.019,0:14:44.860 in training the baby or the child who needs[br]to get the most out of their implant. However, 0:14:44.860,0:14:50.430 this is so much cheaper than a lifetime of[br]interpreters. I must compliment all parties 0:14:50.430,0:14:55.839 for getting on with the cochlear implant programme[br]and not stinting on this project. Ten thousand 0:14:55.839,0:15:00.310 people have had cochlear implants so far.[br]That is a marvellous achievement and it is 0:15:00.310,0:15:05.330 changing society. There are now only a very[br]small number of children below the age of 0:15:05.330,0:15:11.779 five who use sign language, and BSL may be[br]regarded in the future as being used by fewer 0:15:11.779,0:15:17.610 and fewer deaf people. Who knows what will[br]happen? Many other skills have been superseded 0:15:17.610,0:15:22.709 by technology. We will have to do our best[br]to support those who continue to use sign 0:15:22.709,0:15:29.709 language but they will gradually become a[br]tiny minority of deaf people. 0:15:30.250,0:15:36.899 Some 40% of deaf children have disabilities[br]in addition to hearing loss. Deafness and 0:15:36.899,0:15:43.899 autism or deaf and blind with a learning disability[br]are combinations that are becoming more common, 0:15:44.010,0:15:51.010 partly as a function of doctors saving extremely[br]premature babies who in past years would have 0:15:51.130,0:15:58.130 died. These babies can now survive at 22 weeks'[br]gestation, but with multiple problems. Some 0:15:58.230,0:16:03.700 parents are better than others at caring for[br]a child with challenging behaviour who may 0:16:03.700,0:16:10.700 never live independently but, sadly, some[br]children are effectively abandoned by their 0:16:10.920,0:16:17.920 parents to the state-a sad future for a child[br]following heroic efforts to save an extremely 0:16:18.279,0:16:21.269 short pregnancy. 0:16:21.269,0:16:27.640 I have two questions for the Minister. The[br]first concerns the reducing number, and increasing 0:16:27.640,0:16:33.320 age profile of, qualified teachers of the[br]deaf. The report stresses the importance of 0:16:33.320,0:16:37.720 good health education for deaf people. Deaf[br]children and young people need to be equipped 0:16:37.720,0:16:43.870 with information and strategies to access[br]health services independently as adults. To 0:16:43.870,0:16:50.589 achieve that, we will need more teachers of[br]the deaf. How can we get them? 0:16:50.589,0:16:54.910 The noble Baroness was asked a very similar[br]question in a debate last October by my noble 0:16:54.910,0:16:58.839 friend Lady Brinton, and she replied with[br]information about the national scholarship 0:16:58.839,0:17:05.079 fund. How many teachers have applied for,[br]and how many have been granted, help from 0:17:05.079,0:17:11.749 this fund to train as teachers of the deaf?[br]It appears that this fund is not working well 0:17:11.749,0:17:17.339 enough to solve the problem, so what else[br]can be done to encourage more teachers to 0:17:17.339,0:17:20.220 work in this specialist area? 0:17:20.220,0:17:26.769 Secondly, can we increase the amount of communication[br]in our health service that is duplicated both 0:17:26.769,0:17:33.600 verbally and by text? It is far cheaper to[br]have a text system of booking appointments 0:17:33.600,0:17:39.109 than an interpreter, and that expenditure[br]will benefit not only deaf patients but all 0:17:39.109,0:17:43.749 patients who can read and write in English. 0:17:43.749,0:17:50.749 My Lords, having seen the title of the SignHealth[br]report, I was surprised by nothing that I 0:17:54.009,0:17:56.720 read in it. If you think about it, when you[br]are dealing with a medical situation, being 0:17:56.720,0:18:03.720 able to tell somebody what the matter is has[br]to be a huge advantage. Man as an animal is 0:18:10.970,0:18:15.429 supposed to be a compulsive communicator.[br]One major thing that we do is to talk to each 0:18:15.429,0:18:19.549 other and if something gets in the way of[br]being able to communicate properly, we will 0:18:19.549,0:18:26.549 have problems. The question is: how do we[br]deal with that? We will never get it absolutely 0:18:27.090,0:18:30.119 right. 0:18:30.119,0:18:37.119 I have to declare an interest. I am chairman[br]of a company called Microlink, which supports 0:18:37.720,0:18:43.119 disabled people through its innovations, usually[br]involving computing. This has led me to take 0:18:43.119,0:18:48.179 a closer look at this area. Indeed, one of[br]our case studies concerned being an online 0:18:48.179,0:18:55.179 interpreter. Most of us are online. It is[br]a much better use of an interpreter's time 0:18:56.919,0:18:59.679 to be able to use British Sign Language online[br]than it is for him or her to have to follow 0:18:59.679,0:19:02.369 a person around. 0:19:02.369,0:19:08.059 In addition, if we are supposed to be enhancing[br]the dignity of a person, we want to give them 0:19:08.059,0:19:15.059 as much independence as possible. A translator[br]is an expensive, difficult piece of kit you 0:19:15.519,0:19:22.049 may not want in the room when you are talking[br]to your doctor about, for example, sexual 0:19:22.049,0:19:29.049 health or reproduction, particularly if they[br]are there all the time. Having something online, 0:19:29.989,0:19:36.989 as described here, seems a perfectly sensible[br]way forward but to use it both parties must 0:19:39.039,0:19:45.090 know that it is possible and how to access[br]it. Making sure that that information is discerned 0:19:45.090,0:19:51.600 throughout the system for the client base[br]and the provider is essential to getting the 0:19:51.600,0:19:58.600 best out of it. That must be looked at and[br]people must know it is available. If it can 0:20:00.720,0:20:07.330 be done comparatively easily, which seems[br]to be the case, everyone must know. That would 0:20:07.330,0:20:13.590 enhance the dignity of the patient and make[br]the job of the doctor easier. We can go into 0:20:13.590,0:20:15.139 the night speaking about that. 0:20:15.139,0:20:22.139 As the noble Lord, Lord Borwick, has mentioned,[br]lots of technologies are language-based. If 0:20:22.950,0:20:29.950 you are literate, you would have another means[br]of communication. As someone who is dyslexic, 0:20:32.019,0:20:39.019 I have a little story about one of these bits[br]of technology. Through the aforementioned 0:20:43.720,0:20:50.720 interest, I saw a wonderful piece of kit which[br]addresses literacy and gives a person some 0:20:51.759,0:20:54.899 personal space. The UbiDuo comes from the[br]States, although I do not think that we would 0:20:54.899,0:20:57.970 have given it that name. Basically, you use[br]two keyboards and two screens that are roughly 0:20:57.970,0:21:04.970 the size of small computers, and you get instant[br]translation of your communication to someone 0:21:06.389,0:21:12.350 else. They can read it and communicate back.[br]I was shown this at a conference where everyone 0:21:12.350,0:21:16.309 else was oohing and ahing about it. I discovered[br]that I was the only person who could not use 0:21:16.309,0:21:23.019 it because I am dyslexic, which shows that[br]everything has its limitations. However, if 0:21:23.019,0:21:29.909 you are informed and know what is going on,[br]you can overcome that and get through to the 0:21:29.909,0:21:35.059 other person. A line of communication can[br]be established. There are many different types 0:21:35.059,0:21:40.220 and uses of language. If we can establish[br]the fact that they are available and known 0:21:40.220,0:21:46.029 about, these problems will be cut. 0:21:46.029,0:21:53.029 Most of what we are talking about will cut[br]across government departments. How would anything 0:21:54.379,0:22:00.649 being talked about here not be covered in[br]one's health employment profile? I bumped 0:22:00.649,0:22:04.239 into Mike Penning, the disability Minister,[br]who said that he is going to try to work across 0:22:04.239,0:22:10.720 departments. It is nice to know that disability[br]has been slightly pushed up and now has a 0:22:10.720,0:22:17.720 Minister of State. There will be the same[br]problems in health, employment and education. 0:22:21.759,0:22:28.759 Everything relates and cross-references. How[br]we deal with that is very important. 0:22:29.899,0:22:36.899 When someone leaves a medical establishment,[br]hospital or doctor's surgery, how will they 0:22:43.450,0:22:50.450 interpret the lifestyle and support that they[br]will receive? I know Mike Penning reasonably 0:22:50.489,0:22:56.799 well and he is a tenacious individual but[br]I do not know how much he and Ministers in 0:22:56.799,0:23:02.440 other departments can make sure that this[br]support is followed through. If deaf people 0:23:02.440,0:23:08.489 are overweight and want healthier lifestyles,[br]it is true that they have more trouble accessing, 0:23:08.489,0:23:15.369 for example, exercise and outdoor activity.[br]What are we doing to make sure that they can 0:23:15.369,0:23:22.369 or that they do not have to jump over hurdles?[br]We should be able to take our solution from 0:23:22.840,0:23:25.799 one place to another. 0:23:25.799,0:23:32.799 We have just heard a very positive description[br]of what might happen with cochlea implants. 0:23:32.820,0:23:37.879 That will never deal with all the problems[br]but it might deal with quite a lot of them. 0:23:37.879,0:23:44.879 However, as the noble Lord said, most people's[br]hearing problems are probably late onset. 0:23:46.749,0:23:53.749 As with most disabilities, they build up.[br]The deaf community has vociferous factions 0:23:54.830,0:23:59.609 within it which will tell you that true deafness[br]is something else, that it is what they have 0:23:59.609,0:24:03.440 and not what someone else has, and that their[br]approach and nothing else is the proper one. 0:24:03.440,0:24:09.559 They are like all other communities I have[br]ever met in that regard. However, unless you 0:24:09.559,0:24:15.629 can get an approach which covers a variety[br]of ways of dealing with the communication 0:24:15.629,0:24:22.629 problem, addresses all those areas and accepts[br]that they are all equally valid, you will 0:24:23.349,0:24:29.549 always create more holes, cracks and barriers[br]than you should otherwise have. 0:24:29.549,0:24:36.549 Finally, I have a story about the aforementioned[br]UbiDuo. When Esther McVey was the Minister 0:24:41.399,0:24:46.909 for Disabled People, she was at a conference[br]and decided to have a chat with the deaf man 0:24:46.909,0:24:53.220 who was doing a demonstration. After a long[br]conversation with aides possibly tugging at 0:24:53.220,0:25:00.220 her elbow to get her out of the room, we went[br]along and said, "This is wonderful. Isn't 0:25:01.349,0:25:06.859 it a great piece of kit?". A woman from the[br]next stall said, "I wonder if she would have 0:25:06.859,0:25:13.859 been quite so keen if it wasn't such a tall,[br]good-looking man on the other side". If my 0:25:15.070,0:25:19.789 honourable friend had not noticed that, the[br]woman on the next stall certainly had. Allowing 0:25:19.789,0:25:26.399 someone to interact on a basic human level[br]is what we are after. This is merely an application 0:25:26.399,0:25:31.749 that can be used in the healthcare that we[br]are looking at. Unless we approach it like 0:25:31.749,0:25:38.149 that, we will miss far more opportunities[br]to enhance people's lives overall than we 0:25:38.149,0:25:39.129 should. 0:25:39.129,0:25:46.129 My Lords, I congratulate the noble Lord, Lord[br]Ponsonby, on securing this debate on much 0:25:47.970,0:25:54.970 needed improvements for the health needs of[br]deaf people. Although deaf people have the 0:25:55.129,0:26:02.129 advantage, unlike the blind, of being able[br]to see, the fact that deafness is not a visible 0:26:03.359,0:26:10.359 disability, as the noble Lord, Lord Ponsonby,[br]has said, means that other people are not 0:26:10.379,0:26:17.139 necessarily aware that you are deaf. Therefore,[br]less immediate attention is given in trying 0:26:17.139,0:26:23.899 to help with any problems that the person[br]will be facing. Perhaps that lack of awareness 0:26:23.899,0:26:30.899 of deafness also helps to explain why so few[br]Members of your Lordships' House are taking 0:26:33.320,0:26:36.289 part in this important dinner-break debate. 0:26:36.289,0:26:43.289 As someone who has had hearing problems since[br]my children were born, and as I have now reached 0:26:45.519,0:26:51.669 the limit of what hearing aids can do to help[br]me understand what people are saying, I have 0:26:51.669,0:26:58.669 some, although obviously not a complete, understanding[br]of the problems and frustrations that deaf 0:27:01.460,0:27:08.460 patients face. Most definitely I have sympathy[br]with the concerns so graphically illustrated 0:27:10.330,0:27:17.330 in the pamphlet How the Health Service is[br]Failing Deaf People. It clearly makes sense 0:27:18.399,0:27:25.399 for doctors' surgeries or hospitals to have[br]the kind of BSL support or other technical 0:27:25.639,0:27:32.419 arrangements to hand that the authors of this[br]pamphlet are advocating should be routine 0:27:32.419,0:27:39.419 but clearly are not. Although I suspect that[br]not everyone who is deaf will mind having 0:27:41.279,0:27:48.279 someone close to them speak to the doctor,[br]the individual's wishes should be paramount. 0:27:52.859,0:27:59.859 Surely, it must be of concern to us all that[br]so many deaf people have a considerably poorer 0:28:02.330,0:28:09.330 health record than the average citizen. I[br]was glad to see from a Healthwatch briefing 0:28:09.369,0:28:16.340 sent to me over the weekend that a few areas[br]of the country are beginning to realise the 0:28:16.340,0:28:23.340 extent of the problems that deaf or hard-of-hearing[br]patients face. In 2013, Kirklees Healthwatch 0:28:26.340,0:28:31.539 followed up numerous concerns identified in[br]its survey of the area. I hope that at least 0:28:31.539,0:28:37.479 some of these-for example, deaf awareness[br]training being developed and rolled out for 0:28:37.479,0:28:43.519 provider staff, including handling phone calls,[br]personal visitors and booking of BSL interpreters-are 0:28:43.519,0:28:50.519 beginning to happen. Healthwatch also reports[br]the beginnings of awareness and action in 0:28:51.609,0:28:58.609 areas such as York, Wakefield, Staffordshire[br]and Stockport. As well as the important reasons 0:28:59.759,0:29:06.759 in the pamphlets for the relevant help proposed,[br]there are other reasons why a greater priority 0:29:07.239,0:29:14.239 needs to be given to those who are deaf or[br]in the process of going deaf. Ageing, by itself, 0:29:15.080,0:29:21.779 inevitably brings hearing loss. As people[br]are living considerably longer these days, 0:29:21.779,0:29:28.609 they will have hearing problems for a longer[br]period of their lives. As well as that, the 0:29:28.609,0:29:35.609 way that today's young expose their ears to[br]incredibly loud media sounds will inevitably 0:29:35.809,0:29:42.200 mean that when age kicks in, their hearing[br]loss is bound to be considerably worse, last 0:29:42.200,0:29:46.859 longer and probably start at an earlier age. 0:29:46.859,0:29:51.869 Interestingly, in your Lordships' House, despite[br]all the modern hearing loops that are fitted 0:29:51.869,0:29:58.869 in the Committee Rooms, which others may also[br]have found quite difficult to communicate 0:29:58.929,0:30:05.929 with, I find that the very best hearing loops[br]available are those that we can switch into 0:30:06.899,0:30:13.899 in the Chamber in itself-where we are at the[br]moment. This has a great deal to do with the 0:30:14.799,0:30:20.879 considerable improvements that have recently[br]been completed here, but I suspect that it 0:30:20.879,0:30:26.609 is also helped by the way that the microphones[br]all hang down from the ceiling and speakers 0:30:26.609,0:30:33.609 are located in the seats of every Bench for[br]people to listen through. 0:30:33.729,0:30:40.729 As in so many other ways, because so many[br]noble Lords themselves are going through the 0:30:43.789,0:30:50.789 stages of ageing, including hearing loss,[br]apart from each one of us checking that appropriate 0:30:51.279,0:30:57.279 equipment and help are available in our own[br]doctors' surgeries-which I certainly hope 0:30:57.279,0:31:04.279 every one of us here today will do-debates[br]such as this that seek government backing 0:31:04.409,0:31:11.409 can also help to raise awareness of the necessary[br]action to be taken. 0:31:11.450,0:31:18.450 With that in mind, I look forward to what[br]the Minister can tell us about what the Government 0:31:21.099,0:31:28.099 will do to reassure the noble Lord, Lord Ponsonby,[br]about his six questions and the others that 0:31:28.989,0:31:35.989 we have added. These considerable changes[br]must take place in doctors' surgeries and 0:31:36.409,0:31:43.409 hospitals to meet the wide range of needs[br]described so graphically in the pamphlet, 0:31:44.349,0:31:51.349 How the Health Service Is Failing Deaf People.[br]To continue with such failure would surely 0:31:54.940,0:31:57.389 be a disgrace. 0:31:57.389,0:32:04.389 My Lords, I am very grateful to my noble friend[br]Lord Ponsonby for his initiative and his excellent 0:32:05.570,0:32:12.570 speech. I declare my interest as chair of[br]an NHS foundation trust, a consultant and 0:32:13.119,0:32:18.239 trainer with Cumberlege Connections and president[br]of GS1. 0:32:18.239,0:32:22.789 Parliamentary debates about the quality of[br]public services to deaf people are all too 0:32:22.789,0:32:28.330 infrequent. Therefore, like the noble Baroness,[br]Lady Howe, I welcome the opportunity to put 0:32:28.330,0:32:34.320 that right tonight. As noble Lords have said,[br]it is particularly opportune because of the 0:32:34.320,0:32:40.889 publication on 25 March of this excellent[br]report by the deaf health charity SignHealth. 0:32:40.889,0:32:47.700 I was very privileged to speak at the conference[br]held on 25 March to launch the report. 0:32:47.700,0:32:53.779 As my noble friend said, the report makes[br]very sobering reading. He went through some 0:32:53.779,0:33:00.779 of the details, but the headline results of[br]issues in relation to deaf people in the health 0:33:02.169,0:33:07.700 service-underdiagnosis, poorer treatment,[br]poorer communication and lack of accessible 0:33:07.700,0:33:14.700 health information-are a salutary wake-up[br]call to us all. As the noble Baroness, Lady 0:33:15.599,0:33:22.599 Howe, said, this has been reinforced by some[br]interesting work by local Healthwatches, which 0:33:22.929,0:33:29.919 we were sent over the weekend. The noble Baroness[br]referred to Kirklees Healthwatch, but I also 0:33:29.919,0:33:36.919 notice work in York, Wakefield, Staffordshire,[br]Enfield, Islington and Stockport. All of those 0:33:37.359,0:33:44.259 local Healthwatches are doing good work in[br]their areas. I hope that the Government will 0:33:44.259,0:33:51.259 listen to what Healthwatch is saying and act[br]on some of its recommendations and proposals. 0:33:52.779,0:33:59.779 My noble friend referred to a number of recommendations[br]made by SignHealth to try to turn the situation 0:34:01.129,0:34:07.519 around, such as communications agreements[br]for each deaf person coming into contact with 0:34:07.519,0:34:14.179 the health service. It is surely a sensible[br]recommendation that they should be able to 0:34:14.179,0:34:21.179 book appointments online using SMS text to[br]communicate with services. Also, health information 0:34:21.980,0:34:28.100 needs to be more accessible in other formats,[br]including British Sign Language and subtitles. 0:34:28.100,0:34:33.889 Importantly, there is the recommendation on[br]psychological therapies, which ought to be 0:34:33.889,0:34:40.480 available to deaf people in British Sign Language[br]nationwide. It has been reported to us that 0:34:40.480,0:34:47.480 Ministers have turned that recommendation[br]down. I would be grateful if the Minister 0:34:47.520,0:34:54.520 could update the House on that. If Ministers[br]have turned it down, does she think that that 0:34:58.790,0:35:05.790 is consistent with the Equality Act duty?[br]I want to ask the Minister about this more 0:35:08.150,0:35:15.150 generally. She knows that individual National[br]Health Service bodies and the department's 0:35:15.720,0:35:22.720 arm's-length bodies have public sector equality[br]duties under Section 149 of the Equality Act 0:35:23.150,0:35:30.150 2010. This duty requires public authorities[br]to have due regard to eliminate discrimination 0:35:31.810,0:35:37.490 between those with and without a protected[br]characteristic and to advance equality of 0:35:37.490,0:35:43.180 opportunity between those with and without[br]a protected characteristic. My understanding 0:35:43.180,0:35:49.080 is that that means removing or minimising[br]disadvantages suffered by people in protected 0:35:49.080,0:35:55.070 groups and considering steps to meet the needs[br]of protected groups where they are different 0:35:55.070,0:36:01.670 from those of other people. Public authorities[br]are also under a duty to make reasonable adjustments 0:36:01.670,0:36:07.630 for disabled people to make sure that a disabled[br]person can use a service as close as reasonably 0:36:07.630,0:36:14.630 possible to the standard usually offered to[br]non-disabled people. From the SignHealth work, 0:36:16.170,0:36:23.170 it is pretty apparent that for many deaf people[br]that duty is not being effectively applied. 0:36:29.230,0:36:36.230 Again, what action are the Government taking[br]to monitor the implementation of the Act's 0:36:36.330,0:36:43.330 duty and what action will they take if it[br]is clear that public authorities are failing 0:36:43.880,0:36:50.110 in that duty?[br]We have had some debate about the necessity 0:36:50.110,0:36:57.110 of interpreting services. I have been contacted[br]by a general practitioner who is particularly 0:36:57.910,0:37:04.910 concerned about this issue. She tells me that[br]there is currently confusion in the NHS about 0:37:05.830,0:37:12.290 the funding for interpreters since the reorganisation[br]and replacement of primary care trusts by 0:37:12.290,0:37:19.140 clinical commissioning groups. My understanding[br]is that in many parts of the country primary 0:37:19.140,0:37:26.140 care trusts funded interpreting services but,[br]since they were abolished, there seem to be 0:37:27.860,0:37:32.910 two problems. One is that clinical commissioning[br]groups have not always been prepared to continue 0:37:32.910,0:37:39.910 to fund those services. Secondly, there has[br]been the issue of how GPs might obtain funding 0:37:41.020,0:37:47.070 from NHS England, which is the body that they[br]are now in contract with, for interpreting 0:37:47.070,0:37:54.070 services within their own surgeries. I understand[br]that, while at first some GPs were successful, 0:37:55.210,0:38:01.140 there are indications that funding is now[br]being withdrawn. That means that GPs will 0:38:01.140,0:38:08.140 have to pay for interpreting services out[br]of their practice expenses. Again, I would 0:38:09.270,0:38:15.520 be interested in what the Minister has to[br]say about that. 0:38:15.520,0:38:20.740 The noble Lord, Lord Borwick, made an interesting[br]speech and I certainly take his point about 0:38:20.740,0:38:27.670 literacy and the achievement of the cochlear[br]implant programme. However, I was delighted 0:38:27.670,0:38:33.470 with the official recognition of British Sign[br]Language some years ago. I recall the bad 0:38:33.470,0:38:39.620 old days when some deaf children were forbidden[br]to use sign language at school. We have all 0:38:39.620,0:38:46.620 moved on from that and, for those deaf people[br]who use sign language, it is important that 0:38:46.830,0:38:53.280 interpreters are available in the NHS. I also[br]share his concern-he raised the point that 0:38:53.280,0:38:59.530 we debated in October-about whether enough[br]people are coming forward to train as teachers 0:38:59.530,0:39:02.520 of deaf children. That is a very important[br]point. 0:39:02.520,0:39:07.460 I very much take the point raised by the noble[br]Lord, Lord Addington, about online interpretation. 0:39:07.460,0:39:14.460 He was really saying that that solution was[br]capable of a much wider interpretation than 0:39:16.210,0:39:23.210 simply talking about deaf people themselves.[br]We must surely be on the edge of a revolution 0:39:24.650,0:39:31.650 in communications and the use of IT in the[br]health service. This could clearly bring great 0:39:34.130,0:39:39.700 advantages for many people who find communications[br]difficult at the moment, but I do not think 0:39:39.700,0:39:44.120 it takes away the responsibility of people[br]in the health service to improve the way they 0:39:44.120,0:39:51.120 do things now. It is very clear that some[br]deaf people are finding services very inaccessible 0:39:51.260,0:39:56.800 indeed.[br]I totally agree with the noble Lord: it is 0:39:56.800,0:40:03.800 another way of skinning the cat-that is all.[br]The NHS has a long way to go to use the technology 0:40:04.330,0:40:11.090 that the noble Lord has put forward. I welcome[br]the suggestions that he made. 0:40:11.090,0:40:17.650 My noble friend Lord Ponsonby asked the Minister[br]a number of questions. I would like to put 0:40:17.650,0:40:24.650 forward a number of proposals for the Government[br]to consider. For many years, the outcome of 0:40:25.950,0:40:31.620 health services for deaf people has been overlooked.[br]We are talking about a relatively small group 0:40:31.620,0:40:38.620 of people-people who inevitably find communication[br]difficult. Will the Government consider the 0:40:42.730,0:40:49.730 appointment of a national champion-perhaps[br]a national clinical director-to champion health 0:40:50.140,0:40:56.430 services for deaf people? The clinical directors[br]that the department and NHS England have taken 0:40:56.430,0:41:02.200 on have been outstanding in giving leadership[br]in relation to a number of clinical areas. 0:41:02.200,0:41:08.230 I wonder whether, for deaf people in particular,[br]having a champion at national level could 0:41:08.230,0:41:15.090 help disseminate information and really bang[br]heads together to ensure that much more focus 0:41:15.090,0:41:22.090 is given to the needs of these people.[br]Secondly, will the Minister encourage Healthwatch 0:41:22.170,0:41:28.790 to continue to build on its work to give specific[br]focus on services for deaf people? 0:41:28.790,0:41:33.960 Thirdly, will the Minister encourage health[br]and well-being boards at local level to pick 0:41:33.960,0:41:40.960 up our concerns about across-the-board services?[br]The noble Lord, Lord Addington, made a very 0:41:41.130,0:41:46.350 strong point about the role of the Minister[br]for the Disabled at national level. At local 0:41:46.350,0:41:52.450 level, the health and well-being boards could[br]clearly carry out that same function. 0:41:52.450,0:41:58.140 Fourthly, will the Minister encourage the[br]development of clinical networks in each local 0:41:58.140,0:42:04.080 health area so that there is co-ordination[br]of services across primary, secondary and 0:42:04.080,0:42:07.760 tertiary care as regards the needs of deaf[br]people? 0:42:07.760,0:42:14.760 Finally, will the Minister institute regular[br]meetings between deaf organisations and the 0:42:15.030,0:42:21.050 NHS within each local health area so that[br]there can be proper discussion and debate 0:42:21.050,0:42:26.340 about the needs of deaf people?[br]This is a very important debate and I am sure 0:42:26.340,0:42:31.200 that we all look forward to a positive response[br]from the Minister. 0:42:31.200,0:42:38.200 My Lords, I thank the noble Lord for securing[br]this short debate on the health of deaf people, 0:42:41.810,0:42:47.590 and I welcome the opportunity to discuss the[br]serious concerns that he raises. This has 0:42:47.590,0:42:54.280 been a really good, well informed debate and[br]many excellent questions have been asked. 0:42:54.280,0:42:59.840 I would point out that my scripted speech[br]is six-minutes long, so I hope to answer as 0:42:59.840,0:43:05.710 many of the other questions as possible within[br]the rest of the time available to me. However, 0:43:05.710,0:43:11.820 in tested and time-honoured tradition, I will[br]send a letter to all noble Lords to address 0:43:11.820,0:43:15.650 anything that I have not covered.[br]I would also like to take this opportunity 0:43:15.650,0:43:20.780 to pay tribute to the work of SignHealth and[br]the efforts that it has made to achieve equal 0:43:20.780,0:43:27.310 access to healthcare and better health outcomes[br]for deaf people. The findings outlined in 0:43:27.310,0:43:33.630 its recent report, Sick of It, are truly shocking.[br]The fact that deaf people are more likely 0:43:33.630,0:43:38.860 to have undiagnosed conditions such as high[br]blood pressure and diabetes and that they 0:43:38.860,0:43:45.850 are more likely to receive inadequate treatment[br]when they are diagnosed, is completely unacceptable. 0:43:45.850,0:43:49.840 This Government are committed to delivering[br]health outcomes that are among the best in 0:43:49.840,0:43:55.680 the world for people with hearing loss.[br]Before getting to the main issue of the health 0:43:55.680,0:44:00.860 of the deaf population, I would like to spend[br]a few seconds outlining service improvements 0:44:00.860,0:44:06.500 to those with hearing loss or who are deaf.[br]These include the rollout of a national screening 0:44:06.500,0:44:12.650 programme for newborn children; significantly[br]reduced waiting times for assessment and treatment, 0:44:12.650,0:44:18.030 with almost all patients now treated within[br]18 weeks, with the average being four and 0:44:18.030,0:44:23.490 a half weeks; and greater choice of hearing[br]aid services-for example, through independent 0:44:23.490,0:44:29.170 high street providers. In particular, by taking[br]forward measures which enable the early identification 0:44:29.170,0:44:36.170 of deafness, we are able to provide a clear[br]care pathway for services and enable parents 0:44:36.520,0:44:40.860 to make informed choices on communication[br]needs. 0:44:40.860,0:44:46.850 However, as SignHealth's report shows, it[br]is in the most basic way that we are failing 0:44:46.850,0:44:53.540 deaf patients. Small adjustments could make[br]a real difference by enabling those with hearing 0:44:53.540,0:45:00.300 loss to communicate with their health providers.[br]Have services thought about how deaf patients 0:45:00.300,0:45:06.040 can book a GP appointment if they cannot just[br]pick up a telephone? Once they have made an 0:45:06.040,0:45:09.530 appointment, will they know when their name[br]is called or will they be left sitting in 0:45:09.530,0:45:15.660 the waiting room? Once they get to see their[br]GP or hospital clinician, will they be able 0:45:15.660,0:45:22.660 to communicate with them? I am sure that SignHealth[br]would readily identify with the questions 0:45:25.800,0:45:28.780 I have posed.[br]The noble Lord, Lord Addington, talked about 0:45:28.780,0:45:34.120 the use of technology in communication, and[br]he brings his personal knowledge to bear. 0:45:34.120,0:45:41.120 Online signing is something that might be[br]sensible, and an intelligent use of services 0:45:42.250,0:45:48.770 such as Skype might also be helpful. Critical[br]to all of this-and I shall come to it later- 0:45:48.770,0:45:55.060 is the co-commissioning of these sorts of[br]services. That sort of approach would not 0:45:55.060,0:46:02.060 only give patients their dignity but also[br]help make the GP's job more straightforward. 0:46:05.810,0:46:12.810 The noble Baroness, Lady Howe of Idlicote,[br]urged noble Lords to carry out checks in their 0:46:12.830,0:46:18.850 own practices. I do not think that anyone[br]would dare not to do so after that. Certainly 0:46:18.850,0:46:25.500 with my own practice in Bodmin, in the heart[br]of Cornwall, I can book online to see a doctor 0:46:25.500,0:46:31.640 or a nurse. When I turn up for a visit I do[br]not talk to a receptionist, I just press a 0:46:31.640,0:46:36.930 touch-screen pad which asks me for my date[br]of birth and my gender. It then says, "Ah! 0:46:36.930,0:46:43.770 Are you Mrs Jolly?", and tells me to sit down[br]and wait. All those services would work perfectly 0:46:43.770,0:46:49.030 well with deaf people and there is no reason[br]why they should not be replicated throughout 0:46:49.030,0:46:56.030 the land. What happens behind the consulting[br]room door may not be as good as all of that-I 0:47:00.290,0:47:05.550 just do not know.[br]There are currently over 10 million adults 0:47:05.550,0:47:11.360 in England living with hearing loss; the World[br]Health Organisation estimates that by 2030 0:47:11.360,0:47:17.760 the figure will rise to 14.5 million. It is[br]therefore vital that health and social care 0:47:17.760,0:47:24.150 services are geared up to be able to communicate[br]with deaf people and those with hearing loss 0:47:24.150,0:47:30.120 in order to promote good health and address[br]their health needs. All options should be 0:47:30.120,0:47:36.970 considered. The noble Lord, Lord Hunt, told[br]the House about the public sector equality 0:47:36.970,0:47:42.910 duty. This requires all public bodies, including[br]those who provide health and social care, 0:47:42.910,0:47:47.280 to, "advance equality of opportunity" and[br]to, 0:47:47.280,0:47:51.370 "have due regard to the need to eliminate[br]discrimination". 0:47:51.370,0:47:57.450 SignHealth's Sick of It report is right to[br]remind deaf people that they have a right 0:47:57.450,0:48:02.910 to complain when a service provider has not[br]taken their particular needs into account. 0:48:02.910,0:48:08.850 However, it is up to the service providers[br]to anticipate the requirements of disabled 0:48:08.850,0:48:15.490 people and the reasonable adjustments that[br]may have to be made for them in advance, before 0:48:15.490,0:48:21.520 any disabled person attempts to access their[br]service. The reasonable-adjustment duty is 0:48:21.520,0:48:28.290 an anticipatory duty, so it is just not acceptable[br]for health services not to be equipped to 0:48:28.290,0:48:35.290 provide communication support for those who[br]need it. This may involve the use of British 0:48:38.980,0:48:45.120 Sign Language, but it may also involve the[br]use of basic technology such as display screens 0:48:45.120,0:48:51.340 in GP waiting rooms. It may also involve something[br]as simple as text messaging-nearly all noble 0:48:51.340,0:48:57.950 Lords referred to that-as all of us become[br]increasingly reliant upon this and other electronic 0:48:57.950,0:49:02.640 forms of communication.[br]My noble friend Lord Borwick talked about 0:49:02.640,0:49:09.640 skills possibly being superseded by technology[br]and referred to cochlear implants, texts and 0:49:11.470,0:49:18.200 the internet. I defy any noble Lord not to[br]be touched by the moving story of Joanne Milne 0:49:18.200,0:49:24.560 as she heard for the first time this week[br]but a lot of this will take a long time to 0:49:24.560,0:49:31.560 roll out. It will take a while before the[br]youngsters reach the age of older people who 0:49:34.460,0:49:41.030 are deaf or have hearing loss. This will not[br]be an instant fix. 0:49:41.030,0:49:48.030 I am happy to be able to report that progress[br]is being made on the NHS information standard. 0:49:48.540,0:49:54.820 As part of the commitment to improve the experience[br]of patients using NHS services and empower 0:49:54.820,0:50:01.820 people to be equal partners in their own care,[br]NHS England is developing an information standard 0:50:01.860,0:50:07.630 for the provision of accessible, personalised[br]information. The standard will ensure that 0:50:07.630,0:50:14.630 disabled patients, service users and carers[br]receive information from NHS bodies and providers 0:50:14.670,0:50:21.670 of NHS care in formats that they can understand.[br]It also requires that they receive appropriate 0:50:21.720,0:50:28.720 support to enable them to communicate with[br]service providers. Successful implementation 0:50:29.210,0:50:34.870 of this information standard will improve[br]the health outcomes and experience of disabled 0:50:34.870,0:50:40.700 people. It will also reduce the number of[br]appointments and screening opportunities missed 0:50:40.700,0:50:47.440 by patients who have received invitations[br]or information in formats that are inappropriate 0:50:47.440,0:50:54.440 for them. It is intended that the standard[br]will be finalised in late 2014, with organisations 0:50:55.130,0:51:02.130 required to comply in 2015. Alongside the[br]statutory information standard, NHS England 0:51:03.740,0:51:09.230 will publish guidance on making reasonable[br]adjustments to meet the communication needs 0:51:09.230,0:51:16.230 of service users with disabilities.[br]We know that there is a need to improve both 0:51:16.530,0:51:20.890 the commissioning and integration of health[br]and social care services for people with hearing 0:51:20.890,0:51:27.770 loss, as well as the provision of new and[br]innovative models of care. This is why we 0:51:27.770,0:51:34.150 are also developing a new action plan on hearing[br]loss. The action plan will identify the key 0:51:34.150,0:51:40.020 actions that will make a real difference to[br]health and social care outcomes for children, 0:51:40.020,0:51:45.820 young people and adults with hearing loss.[br]NHS England is currently engaging with a range 0:51:45.820,0:51:51.550 of stakeholders, including the Department[br]of Health, Public Health England, other government 0:51:51.550,0:51:57.400 departments and agencies and key stakeholders,[br]and aims to publish the action plan as soon 0:51:57.400,0:51:58.110 as possible. 0:51:58.110,0:52:05.110 I hope that I have been able to reassure the[br]House that the Government have a strong commitment 0:52:05.260,0:52:12.000 to promoting the needs of deaf people across[br]a range of public services but, in particular, 0:52:12.000,0:52:17.400 ensuring that deaf people have equal access[br]to health and social care and improved outcomes 0:52:17.400,0:52:24.400 equal to people who do not have hearing loss.[br]Equality is the watchword. 0:52:26.840,0:52:33.180 To answer noble Lords' questions, the noble[br]Lord, Lord Hunt, asked about the decision 0:52:33.180,0:52:38.490 on psychological therapy provided in British[br]Sign Language and where the responsibility 0:52:38.490,0:52:45.490 for that should be in specialised commissioning.[br]Following advice from the prescribed specialised 0:52:46.020,0:52:52.230 services advisory group, and in consultation[br]with NHS England, Ministers have taken the 0:52:52.230,0:52:58.100 decision that responsibility for commissioning[br]psychological therapies for deaf sign language 0:52:58.100,0:53:02.510 users should remain with the clinical commissioning[br]groups. 0:53:02.510,0:53:09.510 The noble Lord, Lord Hunt, also made five[br]points. There was that of the national champion 0:53:12.740,0:53:19.620 and how to build on the work thus far. I am[br]happy to take that back and will write to 0:53:19.620,0:53:25.170 him. On health and well-being boards, they[br]should pick up across-the-board services. 0:53:25.170,0:53:29.220 We hope that they are doing so. I suspect[br]that health and well-being boards will, in 0:53:29.220,0:53:36.220 their second report for this coming year,[br]pick up on that sort of thing if they are 0:53:37.260,0:53:43.920 not doing so already. On co-ordination of[br]services, again, it should be within the gift 0:53:43.920,0:53:48.330 of health and well-being boards to ensure[br]that social care and all health services are 0:53:48.330,0:53:55.330 not only properly commissioned but also properly[br]co-ordinated. It sounds an admirable idea 0:53:56.140,0:54:00.270 that there should be regular meetings with[br]the NHS in each local area for people with 0:54:00.270,0:54:07.270 hearing loss and deafness. I imagine many[br]people with other sorts of disability would 0:54:07.770,0:54:11.440 like to see that as well. Perhaps that is[br]something that Healthwatch might be able to 0:54:11.440,0:54:16.120 facilitate. 0:54:16.120,0:54:21.860 Do GPs have to pay for their translation services?[br]Each provider of a public service is responsible 0:54:21.860,0:54:27.780 for ensuring that they make reasonable adjustments[br]to meet the needs of disabled people. This 0:54:27.780,0:54:32.990 is not funded centrally but must be found[br]from within local budgets. 0:54:32.990,0:54:39.770 The noble Lord, Lord Addington, asked about[br]co-ordinating help for deaf people in other 0:54:39.770,0:54:45.110 fields, such as education and employment.[br]The Minister of State for Disabled People, 0:54:45.110,0:54:52.110 in his capacity as chair of the interdepartmental[br]group on disability, recently wrote to Ministers 0:54:52.800,0:54:58.470 in other government departments to ask what[br]their departments are doing to support their 0:54:58.470,0:55:05.470 deaf users.[br]On the questions of the noble Lord, Lord Ponsonby, 0:55:06.220,0:55:13.220 about plans to ensure that NHS Choices increases[br]the number of videos available in BSL, NHS 0:55:14.520,0:55:21.490 Choices is very keen to provide more BSL content.[br]It has approached SignHealth and in turn secured 0:55:21.490,0:55:26.290 funding for the existing BSL videos. Noble[br]Lords might be interested to know that there 0:55:26.290,0:55:31.950 are videos available on: breast cancer, diabetes,[br]heart disease, lung cancer, prostate cancer, 0:55:31.950,0:55:38.680 back pain, depression and low mood, getting[br]tested for Chlamydia, preventing high cholesterol 0:55:38.680,0:55:42.950 and tinnitus. Those are the ones currently[br]signed. 0:55:42.950,0:55:49.950 What would the Minister recommend to a deaf[br]person who wants to see a doctor but is told 0:55:50.930,0:55:56.090 that no interpreter is available? We recommend[br]that they lodge a formal complaint with the 0:55:56.090,0:56:01.760 GP practice. If the complaint is not resolved,[br]we recommend that the complaint is escalated 0:56:01.760,0:56:08.760 to CCG or NHS England as set out in the complaints[br]procedure. 0:56:10.869,0:56:14.630 What does the Minister think would be the[br]best way to raise deaf awareness among staff 0:56:14.630,0:56:19.950 working in the health service? It is ultimately[br]the responsibility of individual employers 0:56:19.950,0:56:25.410 to support the development of the staff they[br]employ. However, Health Education England 0:56:25.410,0:56:30.060 will provide leadership and work with local[br]education training boards-LETBs-regulatory 0:56:30.060,0:56:36.760 bodies and health care providers to ensure[br]professional and personal development continues 0:56:36.760,0:56:40.650 beyond the end of formal training. 0:56:40.650,0:56:46.119 What steps will the Government take to encourage[br]NHS England and Public Health England to promote 0:56:46.119,0:56:52.600 the health of deaf people? The NHS is a universal[br]service for the people of England and NHS 0:56:52.600,0:56:58.780 England is under specific legal duties in[br]relation to tackling health inequalities and 0:56:58.780,0:57:05.050 advancing equality. The Government will hold[br]NHS England to account for how well it discharges 0:57:05.050,0:57:07.840 these duties. 0:57:07.840,0:57:13.340 Can we expect NHS computer systems to be able[br]to tell us how many deaf people there are 0:57:13.340,0:57:19.810 and which services they are accessing? The[br]short answer is regrettably no, not yet. However, 0:57:19.810,0:57:26.369 the new system being commissioned by NHS England[br]to upgrade the hospital episodes statistics-the 0:57:26.369,0:57:33.369 HES service-will mean that they include a[br]richer source of hospital data, plus data 0:57:33.610,0:57:39.210 from care provided outside hospital. While[br]this will not tell us how many deaf people 0:57:39.210,0:57:46.210 there are, it will tell us about deaf people's[br]access of services. I am sure other improvements 0:57:46.570,0:57:53.369 to care data in time will be able to give[br]us the number of deaf people there are. 0:57:53.369,0:57:57.850 Will implementation of the proposed information[br]standard be supported by a funded programme 0:57:57.850,0:58:03.640 which can help to educate and support? As[br]part of the engagement activity, we asked 0:58:03.640,0:58:10.369 health and care professionals and organisations[br]to advise us as to the challenges they experience 0:58:10.369,0:58:15.550 in meeting the communication needs of patients,[br]carers and services users, as well as the 0:58:15.550,0:58:22.550 ways they have identified to overcome the[br]challenges. These will be reviewed. The intention 0:58:22.980,0:58:28.220 is that the findings will inform the drafting[br]of the standard itself and the development 0:58:28.220,0:58:33.869 of supporting tools. Regarding the psychological[br]therapies question, following a device from 0:58:33.869,0:58:40.869 the prescribed specialised services group,[br]Ministers have decided that these services 0:58:45.770,0:58:48.110 should be commissioned by CCGs. 0:58:48.110,0:58:55.100 I move on to the question of the noble Lord,[br]Lord Borwick: what can be done to encourage 0:58:55.100,0:58:59.520 more teachers to work in this specialist area?[br]Schools and local authorities are responsible 0:58:59.520,0:59:05.790 for assessing their workforce and have adequate[br]recruitment and training strategies in place. 0:59:05.790,0:59:11.980 We expect authorities to work with schools[br]so that they know and build the appropriate 0:59:11.980,0:59:17.690 skills for the teaching workforce, and the[br]DfE is funding scholarships for teachers to 0:59:17.690,0:59:24.690 develop their knowledge and skills, including[br]postgraduate qualifications. Regarding the 0:59:25.690,0:59:32.690 question of texting information, this sort[br]of thing is a local decision. I have told 0:59:33.930,0:59:40.930 noble Lords how my local GP practice chose[br]to sort it, and others may choose to use texts. 0:59:41.270,0:59:48.270 On teacher numbers, so far 600 teachers have[br]achieved or are working towards a qualification 0:59:49.110,0:59:54.750 relating to special education needs, and a[br]further 500 have applied for the current funding 0:59:54.750,1:00:01.750 round. I have exhausted the supply of responses[br]from the Dispatch Box, but I feel absolutely 1:00:05.070,1:00:12.070 sure that when we go through Hansard, many[br]more questions that will come to light, so 1:00:12.840,1:00:19.840 we will write a letter to all noble Lords[br]who have taken part in [br]the debate.